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While it is rare for a person to be born without an eye, it is unfortunately an all too frequent occurrence for patients to experience loss of an eye due to trauma, infection or an underlying disease state. Surgical removal of an eye (enucleation) is performed to remove an ocular tumor, relieve a blind painful eye and save the other eye from an immune reaction stimulated by a traumatized eye. Once an eye is removed it is important that the loss in orbital soft tissue be replaced with a suitable implant to provide normal cosmesis.
Hydroxyapatite is a calcium phosphate hydroxide compound made up of multiple interconnecting pores. Because this is an inert porous substance, once implanted into the orbit it becomes vascularized and hence an integral part of the orbit. In recent years, porous polyethylene implants have been utilized in a similar fashion. Once healed the integrated implant becomes vascularized and provides excellent motility. Commonly patients who desire improved motility undergo "peg drilling". In this procedure a hole is drilled into the front surface of the implant and a peg is inserted into this hole. This peg articulates with a "dive in the back surface of the prosthetic eye thereby providing improved motility.
Complications associated with orbital implants also appear to be much lower with integrated orbital implants when compared to silicone or glass implants (i.e. extrusion, migration, contraction of fornices and superior sulcus deformity). Implant exposure is the most frequent complication that can be managed with different surgical and non-surgical methods.